Infectious Disease

Knowledge of one’s HIV serostatus helps improve quality of life for those who test positive and decreases the risk of HIV transmission. WHO recommends that all participants in HIV prevalence surveys be provided access to their test results, especially those who test HIV positive. Anonymous Vietnam HIV sentinel surveillance (HSS), implemented since 1994, focuses on people who inject drugs (PWID), female sex workers (FSW), and men who have sex with men (MSM). According to national guidelines, the HIV testing algorithm for surveillance purposes was based on two tests whereas the diagnostic algorithm for individuals was based on three tests. Thus, surveillance test results could not be returned to participants who were instead encouraged to learn their HIV serostatus by testing at public confirmatory testing sites. In 2015, a three-test strategy was applied as part of HSS so that test results could be returned to participants.

Objective:

To describe the implementation and preliminary results of returning HIV test results to participants in Vietnam HIV sentinel surveillance.

HIV surveillance in Vietnam is comprised of different surveillance systems including the HIV sentinel surveillance (HSS). The HSS is an annual, multi-site survey to monitor HIV sero-prevalence and risk behaviors among key populations. In 2015, the Vietnam Administration on HIV/AIDS Control (VAAC) installed the Epi Info Cloud Data Analytics (ECDA), a free web-based analytical and visualization program developed by the Centers for Disease Control and Prevention (CDC) to serve as an information management system for HIV surveillance. Until 2016, provincial surveys, recorded on paper, were computerized and submitted to VAAC, which was responsible for merging individual provincial datasets to form a national HSS dataset. Feedback on HSS issues were provided to provinces 3 to 6 months after survey conclusion. With the use of tablets for field data collection in 2017, provincial survey data were recorded electronically and transferred to VAAC at the end of each survey day, thus enabling instant updating of the national 2017 HSS dataset on daily basis. Upon availability of the national HSS dataset on VAAC’s server, ECDA enhanced wider access and prompt analysis for staff at all levels (figure 1). This abstract describes the use of ECDA, together with tablet-based data collection to improve management, quality and use of surveillance data.

Objective:

To use Epi Info Cloud Data Analytics (ECDA) to improve the management, quality and utilization of the Vietnam National HIV Surveillance data.

HIV testing remains the mainstay of optimal HIV care and is pivotal to control and prevention of the disease, however efforts to attain optimal testing levels have been undermined by low HIV testing especially in developing countries. Botswana in response, amended its Public Health Act in September 2013 but the effect of this action on facility based HIV testing rates has not been evaluated.

Objective:

We aimed to assess the effect of the amended Public Health act of 2013 on facility-based HIV testing in Princess Marina Hospital.

ILINet is a CDC program that has been used for years for influenza-like illness (ILI) surveillance, using a network of outpatient providers who volunteer to track and report weekly the number of visits due to ILI and the total number of visits to their practice. Pennsylvania has a network of 95 providers and urgent care clinics that submit data to ILINet. However, ongoing challenges in recruiting and retaining providers, and inconsistent weekly reporting are barriers to receiving accurate, representative, and timely ILI surveillance data year-round. Syndromic surveillance data have been used to enhance outpatient ILI surveillance in a number of jurisdictions, including Pennsylvania. At present, 156 hospitals, or 90% of all Pennsylvania hospitals with emergency departments (EDs), send chief complaint and other information on their ED visits to the Department of Health’s (PADOH) syndromic surveillance system. PADOH evaluated the consistency and reliability of ILI syndromic data as compared to ILINet data, to confirm that syndromic data were suitable for use in ILINet.

Objective:

Discuss use of syndromic surveillance as a source for the state’s ILI/Influenza surveillance Discuss reliability of syndromic data and methods to address problems caused by data outliers and inconsistencies.

HIV and AIDS is not a new problem to global community and human civilization. Though much efforts had been taken yet its devastating effects can be seen in many areas like human productivity, public health, human rights etc. Nepal is experiencing a concentrated epidemic of HIV with prevalence at, or over, 5 percent in certain high-risk groups, such as intravenous drug users (IDUs), MSM, FSW, and migrant laborers in India who go to cities such as Mumbai. The possibility of transmission of HIV infection from these high-risk groups to the general population is a serious health concern. Nepal’s vulnerability to HIV has increased because of several factors including poverty coupled with the lack of employment opportunities, large-scale migration and ten years of conflict. IBBS survey conducted in 2008 in mid-Terai regions reported the prevalence of HIV among seasonal migrants who had sexual contact with female sex workers in India was 2.6% which indicates unsafe sex being one of the major factors of HIV transmission among the seasonal migrants. Similar study conducted among seasonal migrants reported that only 62% used condom during sex with sex worker and HIV infection was found only on those who visited Mumbai (6.1%) and had sex with sex workers without using condom. Seasonal migration for income generation in Mid-Terai part of Nepal is present since the time immemorial. People migrate to India generally to Bihar, Punjab, Uttaranchal, Maharashtra, Uttar Pradesh, Delhi states. Risk of HIV transmission among the seasonal migrants is very high. Separated from their spouses and adrift from social bindings, many to these migrants exercise unsafe sexual practices. Regular monitoring and health assistance to this population is lacking, especially in the case of those who migrate to neighboring countries like India, compared to those who receive authorized permission to work in other countries.

Objective:

The objective was to assess the risk of HIV infection among the seasonal labour migrants of Nepal.

The mortality monitoring system (initiated in 2009 during the influenza A(H1N1) pandemic) is a collaboration between the Centre for Infectious Disease Control (CIb) of National Institute for Public Health and the Environment (RIVM) and Statistics Netherlands. The system monitors nation-wide reported number of deaths (population size 2017: 17 million) from all causes, as cause of death information is not available real-time. Data is received from Statistics Netherlands by weekly emails.

Objective:

Weekly numbers of deaths are monitored to increase the capacity to deal with both expected and unusual (disease) events such as pandemic influenza, other infections and non-infectious incidents. The monitoring information can potentially be used to detect, track and estimate the impact of an outbreak or incident on all-cause mortality.

With increasing availability of syndromic meaningful use data, new approaches to disease surveillance utilizing linkages to other data systems are possible. Expanded communicable disease information may be valuable during outbreaks or other public health emergencies. San Diego County is experiencing a significant and protracted hepatitis A outbreak. The disease has been transmitted person-to-person through close contact or through a fecally-contaminated environment, and has been primarily affecting homeless people and injection and non-injection illicit drug users. As of August 31, 2017, there were nearly 400 cases with 15 deaths. Approximately, 70% of the cases were hospitalized. This is one of the nation’s largest hepatitis A outbreaks since the introduction of the hepatitis A vaccine in 1995. Additional cases are expected over the next twelve months. The population affected by this outbreak presents some challenges for outbreak response. It is often a difficult population to reach. In addition, many have multiple comorbidities and often have health care seeking behaviors that differ from the general population. Using the medical record number (MRN) to link hepatitis A disease cases from the communicable disease registry to syndromic HL7 messages for emergency department visits and hospitalizations enabled the identification of additional hospital encounters the cases may have had before, during, or following their hepatitis A disease incident. This allowed an exploration of the ways in which this unique population interacted with the health care system in the context of a communicable disease outbreak. This presentation will highlight the steps to link information across surveillance systems, the results, the challenges, and the benefits of linked information to public health departments.

Objective:

To describe how the County of San Diego linked information from a communicable disease registry and syndromic surveillance system to further describe cases associated with a large hepatitis A outbreak. Specifically, to detail the linkage process which resulted in a longitudinal understanding of individuals’ hospital visits before, during, and after the reported hepatitis A incident.

Influenza is a priority in Armenia. There are two influenza surveillance systems in Armenia: population and sentinel. The medical center (MC) has been included in sentinel surveillance since 2012. In 2015 a study was undertaken to identify gaps in severe acute respiratory infection (SARI) sentinel surveillance system in Surb Astvatsamayr MC.

Objective:

The goal of this study was to identify gaps in the severe acute respiratory infection sentinel surveillance system at Surb Astvatsamayr Medical Center.

The Vietnam National HSS was established in 1994. In the late 1990s and early 2000s, when the epidemic was increasing rapidly, the HSS helped with the intensive close monitoring of the HIV epidemic. In its first 10 years, the HSS was rapidly expanded from 6 to 40 provinces and in some years, it was conducted semi-annually. After two decades, the HIV epidemic situation has changed. In most provinces, HIV prevalence has reported to have declined. Compared to the peak period, the HIV prevalence among key populations (KP) in the past decade decreased from 40-60% to 20% or lower. In many provinces, HIV prevalence was less than 10% among people who inject drugs (PWID) and less than 3% among female sex workers (FSW), and among men who have sex with men (MSM) (Table 1). At the same time, the HIV programme has since been scaled up widely with various interventions and expanded to most of the 63 provinces. In 2014, the government of Vietnam and international stakeholders conducted a joint review of the health sector response to the HIV epidemic and concluded that for better monitoring of the epidemic, a more focused and higher quality surveillance system was needed. In 2015, surveillance stakeholders conducted a detailed review of the HSS to discuss prioritization of the surveillance activities.

Objective:

To describe an exercise to identify priority provinces to be focused in the Vietnam National HIV Sentinel Surveillance (HSS).

The Jermuk region of the Zangezur mezofocus is part of the transcaucasian highland focus of plague. This enzootic area is polyvectorial. The mezofocus has rich fauna with approximately eight species of fleas: Callopsylla caspia, Ctenophthalmus wladimiri, Frontopsylla elata, Amphipsylla rossica, Leptopsylla taschenbergi, Nosopsyllus consimilis, Palaeopsylla vartanovi, and Doratopsylla dampfi. Ct. wladimiri is the most abundant. However, special attention should be paid to C. caspia and N. consimilis as they are the only vectors specific for Yersinia pestis. In these fleas, the bacteria form a plug that blocks digestion and induces starvation. Afflicted fleas bite frenziedly in an effort to feed and the pressure that results releases bacteria from the plug, infecting a new host. Fleas infected with plague during an epizootic are a serious threat to humans, especially when in contact with synanthropic rodents. A survey was conducted to catalog fleas in the foci.

Objective:

The goal was to determine the impact of flea number variation on the epizootic situation in the Jermuk region.